DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20194475

Addition of rituximab to hyper-CVAD improves overall survival in newly diagnosed Burkitt leukemia/lymphoma from the Middle East and North Africa region

Najla S. Bin Sabbar, Fatimah S. Alowirdi, Fatimah A. Basakran, Lujain A. Al-Badr, Rawan A. Assiri, Wafa A. Alshahrani, Alaa Althubaiti, Moussab Damlaj

Abstract


Background: Burkitt leukemia/lymphoma (BL) is a highly aggressive malignancy treated with intensive combinational chemotherapy. However, there is paucity in the literature with regards to outcome in patients with BL from the Middle East and North Africa Region (MENA).

Methods: We examined the impact of incorporation of the monoclonal antibody rituximab within a chemotherapy backbone of hyper-fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, cytarabine and methotrexate (hyper-CVAD). Between 2007 to 2016, a total of 21 patients were identified and data retrospectively collected with median follow up was 32 months (1.1-120). The cohort was stratified based on exposure to rituximab and there was no significant difference regarding gender, age, stage, presence of constitutional symptoms, baseline presenting blood counts and proportion of patients completing prescribed therapy regimen between the strata.

Results: Estimated overall survival (OS) of the entire cohort at 2 years was 71.1%; however, patients who received rituximab in conjunction with hyper-CVAD had a statistically significant improvement in 2-year OS at 81.2% vs 40% (p=0.048).

Conclusions: In conclusion, we observed that incorporation of rituximab within a hyper-CVAD backbone improved OS in BL patients from the MENA region. These results warrant further evaluation.


Keywords


Burkitt lymphoma, Hyper-CVAD, Rituximab

Full Text:

PDF

References


Dunleavy K, Little RF, Wilson WH. Update on Burkitt Lymphoma. Hematol Oncol Clin North Am. 2016;30(6):1333-43.

Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375-90.

Magrath I, Adde M, Shad A, Venzon D, Seibel N, Gootenberg J, et al. Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen. J Clin Oncol. 1996;14(3):925-34.

Mead GM, Sydes MR, Walewski J, Grigg A, Hatton CS, Pescosta N, et al. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 study. Ann Oncol. 2002;13(8):1264-74.

Koskela K, Pelliniemi TT, Pulkki K, Remes K. Treatment of multiple myeloma with all-trans retinoic acid alone and in combination with chemotherapy: a phase I/II trial. Leuk Lymphoma. 2004;45(4):749-54.

Thomas DA, Cortes J, O'Brien S, Pierce S, Faderl S, Albitar M, et al. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. 1999;17(8):2461-70.

Dunleavy K, Pittaluga S, Shovlin M, Steinberg SM, Cole D, Grant C, et al. Low-intensity therapy in adults with Burkitt's lymphoma. N Engl J Med. 2013;369(20):1915-25.

Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(4):235-42.

Cortes J, Thomas D, Rios A, Koller C, O'Brien S, Jeha S, et al. Hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone and highly active antiretroviral therapy for patients with acquired immunodeficiency syndrome-related Burkitt lymphoma/leukemia. Cancer. 2002;94(5):1492-9.

Thomas DA, Faderl S, O'Brien S, Bueso-Ramos C, Cortes J, Garcia-Manero G, et al. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer. 2006;106(7):1569-80.

Hoelzer D, Walewski J, Dohner H, Viardot A, Hiddemann W, Spiekermann K, et al. Improved outcome of adult Burkitt lymphoma/leukemia with rituximab and chemotherapy: report of a large prospective multicenter trial. Blood. 2014;124(26):3870-9.